Higher carotid artery backward pressure and load-dependent stiffness among women with a history of preeclampsia: association with cognitive functions

Abstract

Women with a history of preeclampsia (hxPE) show reduced executive function (EF) and processing speed (PS) compared with a healthy pregnancy (HP). Central (carotid) artery pulsatile pressure hemodynamics and stiffness are associated with reduced cognitive function with aging, but it is unknown if this relation exists in women with a hxPE. We hypothesized that higher carotid artery pulsatile pressure hemodynamics and stiffness would mediate reductions in cognitive function among women with a hxPE. Carotid artery applanation tonometry, B-mode ultrasonography, and wave separation analysis were used in 121 postpartum women (9 mo–5 yr after delivery, aged 18–45 yr; n ¼ 59 hxPE and n ¼ 62 HP) to calculate forward and backward pressure wave amplitudes, and pulse pressure (PP). Carotid stiffness components were derived by participant-specific exponential modeling. EF and PS were represented as Z-scores. Mediation analysis determined the contribution of carotid outcomes in association between preeclampsia status and cognitive function. Women with a hxPE had higher carotid Pb, PP, and load-dependent stiffness compared with those with HP (body mass index and age adjusted, P ¼ 0.009, P ¼ 0.005, and P < 0.001, respectively). After education and age adjustment, the hxPE group had significantly lower PS compared with HP (P ¼ 0.009); executive function was not different (P ¼ 0.08). No pulsatile pressure hemodynamic or stiffness factor mediated associations between preeclampsia status and PS (all P > 0.05). Women with a hxPE have greater carotid PP, Pb, and load-dependent stiffness, compared with a HP. Neither carotid artery pulsatile pressure hemodynamics or load-dependent stiffness mediated lower PS among women with a hxPE. NEW & NOTEWORTHY The novel finding is that higher carotid artery pulsatile pressure hemodynamics and load-dependent stiffness do not mediate reduced processing speed performance in young women with a history of preeclampsia. No difference was seen in EF between groups when adjusted for education and age. These findings clarify the contribution of pulsatile pressure hemodynamics to cardiovascular disease risk and highlight the need for future research on cognitive performance in women with a history of preeclampsia.